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Monday was my final final final *crossing my fingers* surgery. Going into it, I felt a little like Veruca Salt. “I want perfect boobs Dr. Festekjian and I want them NOW!” “Festekjian…how much do you want for the perfect boobs? Name your price!” (I guess the answer to that will be arriving after the insurance adjustment in a few weeks!)

But really though. I did feel a bit…oh what should I say…spoiled? After all, I emerged from November’s implant exchange surgery with a pretty decent rack. After the swelling went down and I let things settle in for a month or two, I realized they were a good size and shape. But they weren’t perfect. And perfect is what I wanted, because, well–why not? After all of this–a mastectomy and an infection and reconstruction and all of these surgeries in the name of not getting breast cancer–I might as well get exactly what I want.

The main problems were the unevenness in nipple height and the rippling on the right side. But even the week before the surgery, when I sent an updated photo to a blog follower, she said they looked great and she thought I had already had the surgery to adjust the nipple height! For a moment there I considered canceling the surgery because I didn’t want to push my luck.

But…obviously I didn’t cancel it, and I’m sure glad I didn’t.

Per my usual routine, I spent all of Sunday chugging water like a crazy person to prepare my tiny veins to be poked and prodded. My mom picked me up from my apartment at 6:00 am on Monday morning. Jeani, bless her heart, had scheduled me for the earliest appointment because of the snafu that happened last time.

I checked in at the outpatient surgery center, changed into the sexy hospital gown and matching accessories, then chatted with a nurse. It’s kind of strange when you start to recognize the doctors and nurses…I’m pretty sure this particular nurse, who has been a vegan for over twenty years and always eats salad for lunch, has checked me in three times.

The most miraculous thing happened next. Brace yourself, because what you are about to read may rock your world and make you question everything you know.

A nurse anesthetist came in to talk to me about the anesthesia cocktail and start my IV. She was young, kind…unassuming. Little did I know of the POWERS SHE POSSESSED.

As is custom, my mom and I launched into our tirade about my horrible veins and the atrocities that have befallen me at the hands of IV nurses and anesthesia doctors alike in the walls of the UCLA Medical Center: the constant pokes, the unyielding veins, the need to “call in the big guns” and of course, the multiple PICC lines.

UNSCATHED by these warnings, the young nurse did persist with a smile. “I’ll have to numb you up then!” Haha, you fool! Numbing medicine will do nothing but make my uncooperative veins further retreat into the depths of my wrist/hand/arm/foot/every other part of my body, I mused as she left the room.

Moments later she returned carrying a tiny needle and an IV kit. As she stationed herself to my left, the noble Dr. Festekjian appeared, clad in a red track jacket. As we exchanged the standard hellos, the young nurse poked me with the numbing needle, warning me of a slight sting. “‘Twas nothing”, I murmured.

Then she started the long, daunting process of stabbing me with the IV needle to find a vein. I settled in for the long haul, turning my attention to Dr. Festekjian, when suddenly…within seconds…the voice of an angel rang out.

“All done! Your IV is started.”

A MIRACLE. It took her only ONE TRY, only ONE MEASLY POKE, to start my IV. I wanted to hug her, become her best friend, then follow her around from place to place for the rest of my life so she can always be the one to start my IV.

I was giddy with excitement at this point, but tried to remain steady while Dr. Festekjian played Connect the Dots on my chest with the pretty sterile pen. I figured that if I moved too much and the lines were uneven, it would be my own damn fault if my nips still looked lopsided.

A few minutes later the happy drugs were put into my IV, I was wheeled into the operating room, and then I was out. By 10 am I was awake in the recovery room, and I was discharged by 10:30 am.

Wisely, Dr. Festekjian warned my mom that I would be very bruised and very swollen for a while, possibly with some dimpling. I’m sure he was hoping to avoid the “WTF!” email he received last time. Even with the painkillers, I could definitely feel a dull soreness on my right side where he did all of the work. Even the arm fat near my armpit was super bruised.

I stayed home from work yesterday and today and took a shower this morning. I’m on antibiotics for a few days, and I’m definitely swollen; my right breast looks about one cup size bigger than the left breast, like I have a 1000 cc implant in there instead of 800 cc. And there is certainly some dimpling, mainly where the stitches are holding the skin up. But the nipples sure seem even and the alloderm seems to have gotten rid of the rippling, so I can’t wait to see how they look in a week or two!

My post-op with Dr. Festekjian is on Tuesday morning. I feel okay right now, still a bit sore, but I’ll be returning to work tomorrow. I did go on an hour-long walk this evening to stretch my legs, and that felt great. Hopefully I’ll get permission to head back to the gym next week. Interestingly enough, I am using my pit pillow again. It works well to support my arm when I’m on my computer and when I’m sleeping. Thanks again to my friend Kim who originally introduced me and my mom to pit pillows!

Pictures soon. Right now I’ve got them tucked up nicely in a sports bra so I don’t really feel like digging them out of there.

Instead, I leave you with a photo of the Chester Bug, keeping me company while I worked from home today. Isn’t he just the cutest little kitten? (Yes. I’m that person now. #instacat #catstagram #ilovemycat.)

First off, I want to thank all of my readers for supporting Young Previvors after our Facebook trouble a few weeks ago. Our original group has not been restored yet, nor have we heard anything from Facebook about why the group was deleted. We have, however, started a new Young Previvors group. Our admin, Liz, continues to do a phenomenal job of screening all potential new members, so if you are a previvor or a high-risk young woman, consider joining us. You can email me or search for “Young Previvors” on Facebook.

Things have been uneventful in my world of breast reconstruction, but they’ll pick up a bit in a few weeks. My final-final-final-last-one-I-seriously-promise-you’ll-never-have-to-read-about-it-again-unless-it-looks-ugly surgery is on Monday, February 25. Dr. Festekjian will be doing some minor cosmetic adjustments.

When I saw Dr. Festekjian at my two-month post-op a few weeks ago, I was still concerned about the difference in height between my nipples. Although they’ve certainly improved since my initial implant exchange surgery, the right nipple is still noticeably lower than the left.

At the appointment, Dr. Festekjian asked me point-blank which side I like more. I told him the left side, and to my relief, that was the acceptable answer. He can make my right side match my left side, but because of the extensive work he did on my left side during the implant exchange surgery, he can’t make the left side match the right. Unless, he joked, I get an infection on the right breast. Har har har. Funny.

In the outpatient surgery, he will lift up the right nipple and put some internal stitches in place so it sits higher. He will also add a layer of alloderm underneath my skin, to cover up the rippling. I plan to take a few days off work, but given my quick recovery from the past surgeries, I expect to be back in the office by Thursday. Watch…now that I’ve said that, I’ll have some horrible allergic reaction to the ice cubes in the recovery room and be bed-stricken for the next two months.

Okay, moving on: I have some very important and exciting news to share with everyone. I’d like to introduce you to Chester Frito Horn, my new furry child.

He’s an 18-week-old American medium hair. I officially adopted him from the animal shelter at 11:30 am on Saturday morning, then promptly sent him across the street to the vet surgery center to have his balls removed. Sorry, bug…YOU’RE IN MY WORLD NOW.

I picked him up this afternoon and he seems to be doing just fine. Here he is, Cone of Shame and all. He is now, in my parents’ words, a consultant.

Cat people: how can I get him to stay off of the kitchen counter? I’m scared he’s going to set his tail on fire with the pilot lights on the stove!

Hi friends! I hope you all had a great holiday, whatever you celebrate. Over here at the law firm of Horn, Horn & Horn, we celebrate Hanukkah and Christmas.

It’s been more than a month since my implant exchange surgery, and I am much happier with how the implants have settled in. There is still some difference in nipple height, but I think the breasts have evened out in size and look much more similar.

People have asked me what size I am now. The answer? 14.2 cm 800 cc–duh, obviously.

Don’t worry. I get it. Unless you’re Dr. Festekjian, that means nothing to you. It doesn’t really mean much to me, either. While Christmas shopping at Target a few weeks ago, I bought a cheap bra on a whim. I tried on three different sizes: 36C, 36D, and 38D. The 38D bra fit the best, so right now that’s my size, but I will go to a professional to be fitted soon. (And FINALLY use the Victoria’s Secret gift card my dear friend Anna gave me right after my mastectomy–whoohoo!)

I’ve been dressing up a lot and I love it. If you know me offline, you know that I prefer comfort over style. My weekend uniform consists of yoga pants, a tank top, and sneakers. Sometimes I shake things up with a sweatshirt if I’m feeling daring (or cold). But since I have these brand spankin’ new boobs, I’ve been looking for an opportunity to show them off! Luckily, this holiday season did not let me down.

At the beginning of December, I went to Vegas for my sorority sister Cami’s bachelorette party. My favorite thing about going anywhere with sorority sisters is that we all share clothes. On Friday night, I wore one of Jennifer’s dresses and I actually had CLEAVAGE for the first time since March! Sorry, Bryce.

The next weekend was my company’s holiday party at the SLS Hotel in Beverly Hills. It was amazing. There were EEL TACOS. EEL FREAKIN’ TACOS. I used that magical Forever 21 gift card to buy a cute strapless dress for the party, and I even got to wear my giant heels because Bryce is 9 1/2 feet tall!

“Hey Bryce, how’s the weather up there?”

AND THEN…Cami and her fiance Nick got married this past Saturday! Their wedding was at the Balboa Bay Club in Newport Beach. It was a small, intimate ceremony. Cami looked beautiful! Nick is a lucky man.

I wore the pink dress I wore to my graduation dinner in May. The only difference was that this time I had two boobs! Last time I had one tissue expander and one falsie. I think I prefer the two boobs.

Clearly, I’ve come a long way in my crazy mastectomy journey. But it’s not over yet. I like my implants now. I think they are a good size and they look and feel natural. However, I’m not in love with them.

Should I go back to Dr. Festekjian and ask him to do more work on them? Maybe. Probably. But even then, I won’t be IN LOVE with them. Because I am not IN LOVE with the rest of my body! Until I am completely happy with how everything else looks, I’ll never be 100% satisfied with my implants.

So 2013 is going to be about changing my body the difficult way…without plastic. I’ve struggled with my weight all my life. (Literally, all my life. I learned over Christmas that I weighed over NINE POUNDS when I was born. HOLY SHIT.) Anyway, 2012 was one of those struggle times because of the mastectomy. Now it’s time to get back into shape.

“Stop right now, ma’am! Put the spoon down and back away slowly.”

Here are some of my goals for the new year:

Develop some upper body strength. If my arms look toned, my implants will look better. I am going to keep seeing my physical therapist Jenni to learn how to do this safely.

Get my abs back. Believe it or not, for the first half of high school, my stomach was really toned. I did Pilates all the time and it really worked! Then, for whatever reason, I stopped. And on came the flab.

Get back into spinning. It’s my favorite workout, because it’s effective, and everyone looks like shit afterwards. I know that sounds harsh, but I’m a sweater; no, not a cardigan–someone who sweats a LOT. I hate working out at the gym next to girls with immaculate hair and makeup who look amazing the entire time. NO ONE looks good after 45 minutes on the stationary bike at a spin class.

In addition to spinning, I want to try more cardio. I am going to join a local gym, probably the YMCA, and I plan to take advantage of the classes offered. Dance Aerobics and Zumba both sound pretty fun to me.

Eat out less and cook more (good for the waistline and the wallet!). I need to learn how to cook and be more adventurous with my meals. A few weeks ago, a friend made Bryce and me enchiladas for dinner. He put spinach and mushrooms in mine because I’m a vegetarian. They were DELICIOUS. I would have never thought to put spinach in an enchilada…it was life-changing

Buy a castle.

Appear on Jeopardy.

Win Jeopardy.

I’m not sure yet how I am going to measure my success. My friend at work, Garineh, had a similar New Year’s resolution for 2012. She wrote a blog post on eHow with tips for keeping a resolution. I’ll develop my actual numerical goals based on some of her advice.

One thing is for sure: once I meet my goals, I will have Michelle Obama’s arms, Gwen Stefani’s abs, Wolfgang Puck’s skills, and Warren Buffett’s wealth. (Yeah, that’s how often I eat out now and how much I plan to win on Jeopardy!) Oh and this castle.

It’s been exactly three weeks since the “big unveiling” after my implant exchange surgery. You’ll remember that I was less than pleased with what I saw in the mirror: my left nipple seemed to be about twelve feet higher than my right nipple, and all together the left breast appeared much smaller and tighter. I never thought I’d end up with a rack like Pam Anderson’s after the surgery, but I also didn’t think I’d end up looking like a little kid playing dress up with socks and tissues in her mommy’s old bra.

Hey…I’m a vegetarian too…maybe my boobs WILL end up looking like Pam’s after all!

Dr. Festekjian told me to give it time to settle, even going so far as to suggest that I STOP thinking about my breasts for a while. Fat chance, Dr. Festekjian.

Well I have to give the man credit–he was right. The left breast has settled a lot, looking rounder and less tight, and the nipples are also much more even. Dr. Festekjian said to wait two months, but it’s not even one month after the surgery and I can already see a big difference!

I guess he does know a thing or two about plastic surgery. He’s more than a pretty face, you know.

At my post-op appointment after the implant exchange surgery, he wrote me a prescription for physical therapy. I researched offices in the area that accept my insurance and landed on a place nearby called Women’s Physical Therapy.

My first appointment was Tuesday, December 4. I met with a PT named Jenni. As it was an introductory session, we spent a fair amount of time discussing my mastectomy, complications, and ultimately reconstruction, as well as my goals (get strong in a healthy, safe way) and current exercise plan. Then she took some baseline measurements and stretched me out. The stretching was almost like an upper-body massage; she did a lot of kneading. Knowing that my left implant needs to drop and settle, she showed me stretches I can do at home to help.

Jenni then assigned me some resistance band exercises to work my triceps, biceps and shoulders. I’m supposed to do them every night, and right now they are so simple (just one set of 10 reps) that it takes less than five minutes.

I’ve met with Jenni twice, and I also had an appointment with the Pilates instructor, AnnaLisa. In high school I did mat Pilates DVDs all the time. (Side note: if you are ever in the market for a Pilates DVD, pick an Ana Caban series. AVOID MARI WINSOR LIKE THE PLAGUE SHE IS SO ANNOYING.) This Pilates session was NOTHING like the Pilates I remember! Nope…there was no Seal, no Corkscrew…not even a measly Roll-Up!

Instead AnnaLisa had me focus on very small movements using my muscles in ways I’ve never tried. There was no cardio involved, yet I felt like I did get some sort of a workout. It wasn’t easy! Who knew drawing circles in the air with my elbows could be so tiring? Oy, I was exhausted after!

After my sessions I’ve felt a bit sore, but it’s not alarmingly painful. It’s almost more of a pleasant indicator that the sessions are working and that my upper body muscles are being stretched out and strengthened just a little bit each day.

I have another session with a physical therapist on Friday, and then a few more next week. My schedule is spotty since I signed up with the office so late in the year and I can only stop by in the early morning or late afternoon. Hopefully I’ll be able to set up a steady plan for 2013.

Speaking of 2013, what’s everyone doing for New Year’s and the holidays? Bryce and I are going up to Yosemite for Christmas, where we’ll see my parents and my cousin Justin. Then we’ll be celebrating New Year’s in Redondo Beach. But before all that there’s my company holiday party this Friday night. I stumbled upon a Forever 21 gift card in my wallet (lucky find), so I’m going to treat myself to a new dress for the party–my first since the implant exchange surgery!

Well, I’m signing off. It’s bed time! Now if I could just pry this giant sleeping baby off of my lap…

I’m sorry Bryce, I had to do it. You just look too cute in that onesie.

It’s been ten days since my implant exchange surgery. I admit that I originally planned to post about it much sooner, but emotions took me by surprise and I decided to wait a bit longer. Details about that to come later in this post.

My implant exchange surgery was at the UCLA Outpatient Surgery Center. I was told to arrive between 9:30 and 10 in the morning. I got there on time and completed the necessary paperwork after changing into the lovely surgery garb. Then I waited. And waited. And waited. By 11:45 am, Mom and I were rather annoyed. We were told that Dr. Festekjian was still in surgery from an earlier case.

It’s frustrating…but there’s nothing you can really do in that situation. If some sort of complication happened during my surgery, I’d want Dr. Festekjian to care about fixing it instead of trying to rush so he could get to his next case.

Finally Dr. Festekjian came by around 12:30 pm and drew all over me in marker. My chest looked like a game of Connect the Dots. Then the anesthesiologist stopped in to ask me a few questions and to start my IV. If you’ve been following my blog, you know about the IV drama. Well, the saga continued with this most recent surgery:

I mentioned to the anesthesiologist that I have very bad veins. After much prodding and examining, he informed me that “whoever said you had bad veins was wrong; you have NO veins.”

Well, shit.

He first tried my left hand. The needle went in and he poked around for a while but couldn’t get into a good vein. Ouch. Then he got wise and gave me a numbing shot, got down on his knees and poked my left wrist. After a few minutes he struck gold. Rejoice! No more poking. After he finished, he remarked that I could now put it on my CV that I “bring doctors to their knees.”

My veins really piss me off. Let me just rant for a minute: WHY ARE THEY SO AWFUL?! The day before my surgery I drank more than 80 ounces of water just to plump them up. And it was all for naught, because I still had to get stabbed multiple times! BLEHHHHH.

After the IV fun, I was wheeled into the operating room. That’s always a strange experience, because the anesthesia sleepy medicine has just been administered so I start to feel a bit giddy but I’m still coherent. Also, the operating rooms are never what I expect them to look like. I guess I’ve seen too many dramatic operating room scenes on TV.

Well I guess I conked out, because a while later I woke up in a recovery room to the sight of my friend Dustin, a first year UCLA medical student. Dustin and I went to high school together. He stayed with me for about 45 minutes, which was nice because it forced me to stay awake and to come out of my loopy state.

I was discharged around 4 pm and at my parents’ place in Redondo Beach by 5:30 pm. Bryce had a nice cold Jamba Juice waiting for me, and my mom whipped up some tomato soup. Yum. (I could really go for that right now, actually…)

All in all, the surgery process and immediate recovery was very reasonable. I did not take any narcotic pain meds (Tylenol was fine), and I could move around the house with relative ease.

Wednesday morning was the “big reveal,” the first time I would see my implants after surgery. I woke up early, excited to see them. I stood in front of the bathroom mirror, eyes closed, while Mom helped me cut off the ace bandage bra. The bandages were removed…I opened my eyes…and…

bleh. Bleh bleh bleh. I was not happy. My new breasts looked completely uneven. The left side was small and tight, while the right side seemed large and droopy. The nipples were no where near even. North and South Pole!

I stared for a while and then started to get emotional. Mom snapped some pictures and fired off a distraught email to Dr. Festekjian. I texted Bryce a very cryptic “my boobs look bad I’m sad leave me alone” kind of text, posted a quick “OMG” message to the Facebook previvor group, then cried myself back to sleep.

A few hours later I woke up to a reply from Dr. Festekjian and a bunch of comforting messages on Facebook. Apparently I was the only person in the world who did not know that you cannot judge the implants’ appearance immediately following surgery. Things are swollen, bruised, tight, uneven. They need to settle, and that takes time–weeks to months, even.

In addition to his email reply, Dr. Festekjian called later that day. He explained in detail that my left side had more scar tissue from the infection, so he did much more work on that side. Over time that side will drop and adjust to match the right side.

Well…that makes sense. The more he explained, the more I understood. He said he was still very happy with the results and could see symmetry in the breast folds. I don’t particularly know what that means, but a happy Dr. Festekjian is never a bad thing.

The reason I didn’t post on my blog that day or even the day after is that I didn’t want to be too emotional and scary. Emotion is good–and it’s honest–but I didn’t want my uneducated, post-surgery freakout to worry someone else who might be having the surgery. I hope that makes sense.

Yesterday I had a post-op appointment with Dr. Festekjian. Already he can tell that the left side is settling more. He said I should give it about eight weeks to relax into place, and that my right side will not drop anymore. We discussed options for after that eight weeks is up, incase I’m still not happy with the results. Fat grafting could be done to fill out “bumpy” areas (such as underneath the breast) and nipple alignment could also be adjusted. Insurance will cover those procedures since they are still a part of breast reconstruction.

I’m very pleased to know that I have options in the near future if I’m still not happy. But for now I’ll try to give it a rest and let nature take its course. Dr. Festekjian advised me to “stop thinking about your breasts for a little while.” I’m not so sure I’ll ever be able to do that, but I’ll try.

For now I leave you with these two comparison shots of the tissue expanders and implants. The implant shots were taken this evening. Also, if you are interested in seeing a comparison shot without the sports bra, send an email to rachel@tickingtimebombsblog.com. If I determine that you are not a creepy spammer/stalker, I will send you the pic.

That’s right. You read that correctly: I GET MY SILICONE IMPLANTS ON MONDAY.

I’m going to be honest with you–that’s something I never in a million years would have expected to ever say, write or even think in my life. Me? Breast implants? Nah, never, not for me…but it’s happening! I’ll eat those thoughts with a fork and spoon (just not after midnight on Sunday).

After more than one year since finding out about my BRCA mutation and more than eight months since my original mastectomy, I am finally going to be done with surgery. I almost don’t believe it’s real, but it is–two breasts, four Jackson-Pratt drains, three tissue expanders, one cellulitis infection, two falsies and many wireless bras later.

I had a pre-op appointment with Dr. Festekjian on November 8. He told me my implants will either be 700 ccs or 800 ccs, most likely Natrelle style 45 silicone. A few posts earlier I said that I probably wouldn’t get those implants because they’re very narrow, but Dr. Festekjian knows that I am most concerned about projection and they offer the highest projection. The total size of the implant (700 vs 800 ccs) depends on the width he needs to cover (13.5 cm or 14.2 cm).

At this point I’ve really stopped worrying about what size my implants will be. I trust Dr. Festekjian’s judgment completely. He did such a good job with my tissue expanders; people are always surprised to find out that my tissue expanders aren’t actually my permanent breast implants.

The night before my surgery I plan to take some photos of my chest with tissue expanders. I really want to create a visual of the different “stages” of breast reconstruction. The final stage photos won’t be ready for a few weeks since there will be swelling after the surgery.

I’m the worst blogger, I know. I’m sorry. I moved into my new apartment in September and I still don’t have Internet, but I don’t want to get it until I get a TV, which should be around November 10. For now, I have to mooch teh Interwebz off of work and my friends. But it is really awkward to post a new blog entry at work, when all of my blog posts have pictures of my boobs. It just doesn’t seem like the best idea, you know?

Let me update you on my breast reconstruction status: I had my final tissue expander fill with Dr. Festekjian on October 4. He filled each expander up to 700 ccs of saline. My expanders can hold up to 750 ccs, but Dr. Festekjian discouraged me from filling anymore. He said that the expanders already felt very firm and that the skin was tight, so more saline could be painful for me.

Stopping at 700 ccs was fine with me; I’m (at last) happy with the projection of my tissue expanders. You can’t see much of a difference between 650 ccs and 700 ccs, but here’s a comparison:

My implant exchange surgery is set for Monday, November 19, which is the Monday before Thanksgiving. I’ll be taking Monday, Tuesday, and Wednesday off work, then Thursday and Friday are vacation days. I should be back to work the following Monday.

Here’s me and my 700 ccs of saline on each side!

Last Wednesday was Breast Reconstruction Awareness (BRA) Day at UCLA Medical Center. I went with my mom and Bryce to show some love for Dr. Festekjian. I’m actually really glad we went; I didn’t think I’d learn much, but I asked Dr. Da Lio (another plastic surgeon) about the differences between silicone implants and “gummy bear” implants.

I’ve been hearing a lot about gummy bear implants lately, and I wanted to know what was so great about them. Dr. Da Lio told me that UCLA does offer gummy bear implants (a form of very dense silicone implants), but they are not yet approved by the FDA so patients who opt for them must participate in a study. He said they’re firmer than silicone implants and that they retain their shape when cut. But the negative is that they are not a perfect circle (unlike other implants); if they flip around under the muscle, the breast shape will change. They are not guaranteed to flip, but Dr. Da Lio said that upper body exercise could make it happen. I like to kayak and I want to get into weight lifting, so the risk of gummy bears flipping is there for me. Silicone implants it is!

I’ll be going in for a pre-op appointment with Dr. Festekjian on November 8. I already know that he is going to order a few different sizes of silicone implants for me, but hopefully he’ll give me some idea of the actual numbers and sizes.

Once my implant exchange surgery is done, I should be finished with surgeries. Since I had a nipple-sparing mastectomy, I don’t need to worry about nipple tattoos. But when I was at BRA Day, I met a tattoo artist named Ruth Swissa who does medical tattoos for breast reconstruction patients. Her work was AMAZING! She had a bunch of temporary 3D nipple tattoos. They looked SO REAL. She had one on her arm and if I didn’t know anything about mastectomies or breast reconstruction, I would have been really freaked out by it because it really did look like she had an oddly-placed nipple! To any of my readers who are going to have nipple reconstruction: email me if you want a few of the nipple tattoos! I snagged some and would gladly mail a few to you.

OK, I’ve been mooching off of my friend’s Internet for too long. Happy Halloween, everyone! I leave you with this picture from Saturday evening of Bryce and me. Can you guess who we are?

Is it really Sunday evening already? Where did the weekend go?! (Note: It’s now Monday and I am posting this while at work since I don’t have access to the Interwebz at home!) Well, now’s the time for reflection…starting with last weekend!

Last Sunday I attended a FORCE meeting in Agoura Hills. FORCE (Facing Our Risk of Cancer Empowered) is an organization focused on hereditary breast and ovarian cancer. There are chapters all over the country, including a few in Southern California. Until last week, I’d never attended a FORCE meeting.

There were about twenty women present, as well as a few brave husbands. We spent some time mingling and getting to know one another. Trisha was there and since I felt like the awkward new kid, I stuck to her. But I did make some new BRCA friends, too! Finally the guest of honor arrived: Dr. Karam!

If you’ve started reading Ticking Time Bombs recently or you’re a veteran reader who hasn’t been taking copious notes on every post, you might need a quick lesson on Dr. Amer Karam. I always talk about Dr. Festekjian, my plastic surgeon, but he is only half of my mastectomy dream team (I bet you didn’t know there was such a thing!). Dr. Karam is the breast surgeon who performed the first part of my mastectomy in March, removing all of my breast tissue. His official title is gynecologic oncologist; he performed my mom’s oophorectomy in February. We Horns really do like to keep things in the family.

With Dr. Karam’s arrival, we started the actual meeting. First there was a round of introductions; most people shared their name, family history of cancer, BRCA status, and if they have had or are planning to have any surgeries. There were a fair number of women who had already undergone prophylactic mastectomies and oophorectomies, but there were also quite a few who were just beginning to consider surgery.

The Q&A with Dr. Karam was very random and tangential. It seemed that one person’s question would inspire a new question from someone else, and we sort of bounced around the room for a few hours going from question to question. To be honest, all of the talk about breast cancer bored me—it’s really not on my radar anymore since my mastectomy! But I did find the discussions about ovarian cancer and breast reconstruction very useful.

Dr. Karam is a fantastic resource and I think he helped a lot of women at the meeting. He knows how to explain complicated scientific concepts in much simpler, easy-to-follow ways. I felt very proud to tell people there that he was my breast surgeon! It was almost a sort of “hahaha my breast surgeon is better than yours neenerneenerneener sticking my tongue out at you” moment.

The best part of the FORCE meeting was the breast reconstruction “show and tell” at the end! I felt relieved that my tissue expanders looked similar to those of other women at the meeting. And I got to see someone’s “finished product” which made me even more excited for my implants—hers looked amazing! A few of the ladies who are considering prophylactic mastectomies were very impressed by what they saw…my tissue expanders included. I think it’s very helpful and reassuring to see that the final outcome of a horrendous surgery can look so fantastic.

On Wednesday morning I had a tissue expander fill with Dr. Festekjian. I’m now up to 650 ccs of saline on each side, and I can certainly feel more tightness. We talked about what I want in an implant. I am most concerned about projection. Dr. Festekjian mentioned that style number 45 gives the most projection, but those implants are more narrow so they usually look best on people with a small chest. He said the next best option is style number 20, which my mom has.

Just for reference, this is what a tissue expander looks like.

And this is what a silicone implant looks like.

I know for sure I will have one more tissue expander fill, putting me up to 700 ccs on each side. I could go up to 750 ccs, but I think that might be a bit too big for me. These tissue expanders are starting to get pretty bulky! Plus, I want to have the implant exchange surgery on November 19, so the final tissue expander fill needs to be six weeks before that date.

Dr. Festekjian said that he will order a few options for implants. During the actual surgery, he’ll “try them out” to determine which looks best. Gee, it sounds like we’re shopping for prom dresses!

First, a bit of background on the Pan-Mass Challenge: The Pan-Mass Challenge is a bike-a-thon held every summer in Massachusetts. 100% of the money raised by riders is donated to the Jimmy Fund, a cancer research and treatment center at the Dana-Farber Cancer Institute.

My sister Wendy has participated in the Pan-Mass Challenge for twelve years, raising over $127,000 for the Jimmy Fund. This year, my niece Nicole (age 14) and my nephew Matthew (age 16) are stepping up their game by organizing the first Pan-Mass Challenge Teen Mountain Bike Ride, for 13-18 year olds.

The Teen Mountain Bike Ride will be held on October 13 at 9 am in Westwood, Massachusetts. If you know of any teenagers in the Boston area who are in need of community service hours, please let them know about the ride. It sure beats picking up trash on the beach!

Needless to say, I’m very proud of Matthew and Nicole for taking the reins on this idea. The Pan-Mass Challenge is a well-respected event in New England, and there is a similar bike ride for younger kids. Matthew and Nicole saw the need for a ride aimed at teenagers, and they’re making it happen.

Matthew and Nicole, the founders of the PMC Teen Mountain Bike Ride. Just a side note: aren’t they ridiculously good looking?

They’ve always been very receptive and caring kids. This past April, when they came to visit for their spring break, Nicole pulled me aside and asked how my boobs were doing (her words, ha!) Okay, I know that’s not a huge deal, but she’s only 14. (Actually, she was still only 13 at the time!) I was so touched and impressed that she not only understood my choice to have a mastectomy, but that she wanted to check up on me. It’s not exactly a light topic for anyone, let alone a teenager.

It’s time to think about implant sizing! YAYYYYYYYYYY!!!!! [as I type this, I imagine children across America are cheering with delight–because the only thing better than Christmas coming early is that annoying girl with the blog getting her damn breast implants already!]

But seriously. It really is time for me to start thinking about what size I want my implants to be. No pressure, though. I’ll only be stuck with them for ten to fifteen years.

On Thursday morning I had a tissue expander fill with Dr. Festekjian. He filled me up with 75 ccs on the left–yowza, slow down there, Dr. F! No but please don’t, 75 ccs was awesome, thank you. I am now at 525 ccs on the left and 550 ccs on the right. We’re almost even!!!!

At next week’s fill with Maria, I will get 75 ccs on the left and 50 ccs on the right, putting me at 600 ccs on each side. I’m sure what you all want to know is what cup size is that?!

Yes, I’d like to know that, too. So this morning I started to investigate.

The world of tissue expanders and breast implants is terrifying. I have emerged from the deep, dark pit of the Interwebz even more confused than when I started.

This is what I have discovered: I have two Natrelle Style 133SX tissue expanders. They are each 14 cm wide. According to the Natrelle catalog, they have a height of 12 cm and a projection of 7.1 cm and are considered “extra-projection range.” What does that all mean? No idea.

At this point, I am abandoning the science of it until I can talk with Dr. Festekjian, Maria or Jeani about it in person next week. Instead, I am going to play a kind of twisted form of dress up: the Breast Implant Rice Test! Or, in my case, The Breast Implant Israeli Couscous Test!

A few months ago, Jeani explained this test to me but I brushed it off as pretty much ridiculous. However I came across it again today and decided to just try it. 7/8 cup of Israeli couscous and a knee-high nylon sock (sorry Mom) in hand, I ventured into my room.

If “gummy bears” are the Prada of the implant world and silicone is the Coach, then Israeli couscous and nylons must be the Walmart brand.

Why 7/8 cup of Israeli couscous? Well, the handy little chart from www.justbreastimplants.com said that 1 cup of rice was roughly equivalent to 236 ccs, while 3/4 cup was about 177 ccs. Since my tissue expanders can hold a maximum of 750 ccs and my right expander is currently at 550 ccs, I wanted to experiment with about 200 ccs…so 7/8 cup of couscous sounded accurate.

Here’s the results–keep in mind I only tried the test on my right breast, since my left tissue expander is still a few ccs smaller:

Now obviously it looks a bit awkward with the rest of the nylon sticking out, but the test was more successful than I expected.

Yet I still don’t know how I feel about the size potential! The fact is that tissue expanders are shaped differently than breast implants. I need to find out from Dr. Festekjian what kind of implant he plans to use. Right now, when I look at myself head-on, my chest seems to be very filled out; but when I see myself from the side, it still seems very small. I guess this has to do with the tissue expander being wide?

Perhaps next weekend I will try the rice test again, but on both sides (since they’ll finally be the same size again!)

Can anyone speak to their experience with implant sizing?

In other news, I’m sick–but don’t worry, it’s (for once) NOT related to my tissue expanders! On Tuesday I started to develop a sore throat, and by Wednesday afternoon I could barely talk. I stayed home sick from work on Thursday. I felt AWFUL…couldn’t swallow because my throat was so sore, couldn’t sleep…finally saw a doctor on Friday and I’m on antibiotics now. I know, right–more antibiotics?! Ha. Let’s hope I don’t get sick for years after this, because all that nasty little bacteria is going to be SO antibiotic-resistant!

I’m feeling much better today. My mom is coming home today from Yosemite. I heard my dad on the phone with her yesterday, remarking about how I was a horrible patient. (Note to Dad: Yeah, yeah, stick it in your ear. Who do you think I got it from anyway? Plus, here’s a direct quote from “Jewish as a Second Language“, the book you gave me to read: “…should illness or injury strike you, it’s your duty to stay sick as long as you can. Keep using those crutches. Prop them up where everyone can see them. Flash that sling. Enlarge that bandage. Who knows when you’ll be dealt this card again?“)

It’s a good thing Mom is coming home now, because it’s probably her fault I’m sick. Let’s think about this for a minute: where was my mom when I got my cellulitis infection? The Grand Canyon. Where was my mom when I thought I had another infection a few weeks ago? Yosemite. Where was my mom when I got sick this past week? Yosemite, again.

COINCIDENCE? I THINK NOT! Once again, my mom has found a way to SINGLE-HANDEDLY ruin my life.

OK, I’ll stop dicking around now–I hope you all know I’m just being a brat for the sake of humor and that it’s an inside joke with my mom that was started in like, middle school.

I only mention being sick this week because, as much as it sucks, it’s kind of cool in a way that it wasn’t related to my mastectomy or reconstruction at all! It was just because I’m a normal person who can contract normal person contagions from other normal people. I’m normal, ya’ll!

Well, this is the longest I’ve gone without posting…I know I know, I’m a bad blogger! But better late than never.

Now, I know you’re all dying to hear about my trip to Vegas. I’d like to tell you about how awesome it was and how much richer it made me, but sadly I cannot report those glorious things…because I didn’t go! Whomp whomp…

On Friday afternoon (August 24) I left work early for my scheduled fill with Maria, Dr. Festekjian’s wonderful nurse. I was supposed to go straight from UCLA to Long Beach where I would meet my friends and we’d hit the road to Las Vegas. But at the appointment, Maria noticed a slightly red spot on my left breast.

DUN DUN DUNNNNN (onomatopoeia anyone?). Red spots are not good, especially not for Her Royal Majesty the Queen of Cellulitis. I was pretty peeved because that spot had NOT been there in the morning.

Maria of course did the right thing by exercising caution, and in retrospect I’m glad she did—but believe me, in that moment I was not too pleased. I mean, come on…say it with me now…REALLY?! SERIOUSLY?! A RED SPOT…AGAIN?! #$*)(#@*$R JFAJFDSAF*#!)$#!

She decided to call Dr. Festekjian and consult with him. Well it just so happens that the good man himself was already stopping by UCLA (he spent the day working at the VA) so he came in to investigate. He poked and prodded for a while before determining that “he was not impressed.”

HOWEVER…given my history of infection, Dr. Festekjian decided to put me on antibiotics. He also advised that I avoid submerging myself in water (read: no swimming) and that I avoid sweating excessively (read: no 100 degree heat). Well, damn. Vegas in the summer without drinking, swimming and sweating just didn’t sound like very much fun.

Neither Dr. Festekjian nor Maria suggested I cancel my trip, but Dr. Festekjian did say that if the red spot worsened, I would need to come back in and possibly start IV antibiotics. BLEH! The thought of driving all the way to Vegas just to turn around and drive all the way back to Los Angeles was not very appealing.

I consulted my friends about it and they all agreed that it was not worth risking my health just for one weekend. We were able to reschedule the trip, and my friends still had fun doing touristy things around LA (they’re from Northern California). Side note: As much as it upset me to not be able to go to Vegas, I was still very touched by my friends’ response to the sudden change in plans. They were all so understanding and flexible, and even served as a sort of voice of reason for me when I was trying to figure out how to handle the situation.

Even though we didn’t make it to Vegas, we still had a fun weekend. Thanks Kim, Jo and Jill!

OK, so fast forward to this past Thursday. I went to UCLA to see Dr. Festekjian, and he confirmed that the red spot was gone and that we could proceed with my tissue expander fills. I am pretty sure the red spot was probably not an infection; if anything, I think I just slept on my tissue expander wrong and the pressure created that discoloration. But I am happy that we did not just dismiss it. I’ve come too far on this road to let it get screwed up, so being cautious is necessary.

Since Dr. Festekjian and Maria decided against giving me a fill that previous Friday, I was behind 50 ccs. I did manage to talk Dr. Festekjian into giving me 75 ccs during Thursday’s appointment. So now I’m at 400 ccs on the left and 550 ccs on the right. We’re catching up, baby!

My next tissue expander fill is on Friday afternoon, and after that I’ll be…wait for it…MOVING INTO MY NEW APARTMENT!

Yep, that’s right. I’m saying GOODBYE to my parents’ place in Redondo Beach and moving out into the real world! I managed to find a relatively-inexpensive (by LA standards) apartment a few miles from my office. The biggest perk will definitely be skipping out on all of the traffic I’ve come to love loathe.

But I will miss my puppy Madeline and my mommy packing me lunch. =( Give it two weeks and I’ll be begging my parents to take me back!

I love Hendrix. Also, that is Bryce’s hand, not mine. I do not have man thumbs.

I hope everyone had a great Labor Day. Bryce, Hendrix, and I spent the weekend up in Yosemite. I’m happy to report that I went kayaking on the lake twice and I even worked on my shot at the archery range. It’s been about ten years since I last touched an archery bow so I’m a wee bit rusty, but I’ll be back to my Katniss status in no time.

The kayaking and archery did make me think a lot about my upper body strength. When all of my surgeries are over (hopefully November) I think my next “project” will be getting some freakin’ muscle. I am such a weakling! Does anyone have any suggestions for upper body workouts? And keep in mind that I have a very short attention span when it comes to exercise. Fun and shiny=good!

Oh you know, just training for the Hundred Years’ War. BATTLE OF AGINCOURT, YEAH! [/nerd]

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Hi, I'm Rachel, your average twentysomething. I'm in a sorority, I just graduated from college and started my first full-time job, and oh yeah, I recently had a double mastectomy! Welcome to my world of BRCA genes, plastic surgery, and snap-in-front bras.

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